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Li W, Ding T, Feng Y, Xu J, Li Z. Study on the impact of air pollutants on childhood asthma in Nanjing based on a distributed lag non-linear model. Front Public Health 2025; 13:1560896. [PMID: 40371287 PMCID: PMC12075223 DOI: 10.3389/fpubh.2025.1560896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 04/08/2025] [Indexed: 05/16/2025] Open
Abstract
Background Asthma, a chronic respiratory disease, is a significant public health concern globally. Air pollution has been identified as one of the key risk factors exacerbating respiratory conditions, particularly in children. Previous studies have shown a correlation between air pollution levels and asthma visits. However, the impact of air pollutants on childhood asthma visits stratified by gender, age and season remains a topic of interest, and further investigation is necessary to comprehend this complex relationship. Objective This study aimed to explore the association between air pollution and childhood asthma visits in Nanjing from 2013 to 2021. It focused on the effects of various pollutants, including PM2.5, PM10, NO2, SO2, CO, and O3, and examined variations in impact based on demographic characteristics (gender and age) and seasonal changes. Methods Data on childhood asthma visits and concentrations of air pollutants were collected and analyzed. The lag effects of pollutants on asthma visits were assessed, and the impacts were stratified by gender, age group (0-5 years, 6-11 years, and over 11 years), and season. Statistical methods were used to identify significant correlations and the timing of maximum effects of pollutants. Results A positive correlation was found between childhood asthma visits and concentrations of AQI, PM2.5, PM10, SO2, NO2, and CO, with the strongest effects typically occurring on lag day 1. The study revealed that PM2.5 and PM10 had a more pronounced impact on females, and children aged 0-5 years were the most affected age group. Seasonal analysis showed that PM2.5 and SO2 had the greatest impact in spring, while PM10 and NO2 were most significant in winter. Notably, SO2 showed no significant impact on childhood over 11 years old or during summer, and the negative correlation between CO concentrations and childhood asthma visits in the summer, while in other seasons, the correlation was positive. Conclusion The findings indicate a substantial effect of air pollutants, particularly PM2.5 and SO2, on childhood asthma, emphasizing the need for targeted pollution control measures. Variations in impact based on gender, age, and season suggest the importance of tailored interventions to protect vulnerable populations, especially young children in urban and industrial areas.
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Affiliation(s)
- Wenjing Li
- Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Ding
- National Climate Center, China Meteorological Administration, Beijing, China
| | - Yahui Feng
- Department of Emergency, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jin Xu
- Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Zhuo Li
- Department of Emergency, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Rönmark E, Bunne J, Bjerg A, Perzanowski M, Winberg A, Andersson M, Platts-Mills T, Hedman L. Prevalence and risk factors for allergic sensitization: 3 cross-sectional studies among schoolchildren from 1996 to 2017. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100150. [PMID: 37781648 PMCID: PMC10510014 DOI: 10.1016/j.jacig.2023.100150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 10/03/2023]
Abstract
Background The prevalence of allergic sensitization and allergic diseases has increased for decades in Northern Europe, but recent studies are lacking. Objective We sought to study the prevalence trends of allergic sensitization, associated risk factors, and the association with asthma and allergic rhinitis (AR) among children in Northern Sweden. Methods Three cohorts of children aged 7 to 8 years participated in a skin prick test (SPT) with 10 airborne allergens in 1996, 2006, and 2017, with 2148, 1693, and 1762 participants tested, respectively, representing 87% to 90% of schoolchildren in the catchment communities. Adjusted Poisson regression was used to identify risk factors for allergic sensitization and the association with asthma and AR. Results The prevalence of any positive SPT response increased from 21% in 1996 to 30% in 2006 and remained at 30% in 2017 (P < .001). Sensitization to cat was the most common for all the years. The risk factor pattern for a positive SPT response was similar in all examinations, with positive and significant associations with a family history of allergy (risk ratio, 1.4-1.5) and negative and significant associations with having a cat at home (risk ratio, 0.7-0.8). The prevalence of physician-diagnosed asthma increased, but the association with allergic sensitization weakened. The opposite trends were found for AR-decreasing prevalence and strengthened association with allergic sensitization. Conclusions The prevalence of allergic sensitization increased from 1996 to 2006 but plateaued in the next decade, whereas the risk factor pattern remained stable. The diverging trends of associations between allergic sensitization and asthma and AR suggest secular trends in the clinical management of allergic diseases.
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Affiliation(s)
- Eva Rönmark
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå
| | - Joakim Bunne
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå
| | - Anders Bjerg
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York
| | - Anna Winberg
- Department of Clinical Sciences, Pediatrics Unit, Umeå University, Umeå
| | - Martin Andersson
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå
| | - Thomas Platts-Mills
- Division of Allergy & Clinical Immunology, University of Virginia, Charlottesville
| | - Linnea Hedman
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, The OLIN Unit, Umeå University, Umeå
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Kan T, Tanaka A, Kanamoto M, Morioke S, Takahagi S, Hide M. Longitudinal prevalence of atopic dermatitis among freshmen at Hiroshima University between 2002 and 2019. J Dermatol 2022; 49:724-728. [PMID: 35315120 DOI: 10.1111/1346-8138.16366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
The prevalence of atopic dermatitis (AD) has been steadily increasing in recent decades, reaching a steady plateau at the end of the 20th century. However, most of them were surveys of children, and the current prevalence and severity of AD in adults are unknown. A longitudinal survey including 40 649 freshmen attending Hiroshima University between 2002 and 2019 was conducted, with the aim to determine changes in AD prevalence in young adults over the age of 18 years. All data were longitudinally collected at a fixed time of the year. The AD diagnosis and severity assessment were made by dermatologists based on the diagnostic criteria in the Japanese Guidelines for AD. History or comorbidities of asthma and allergic rhinitis/conjunctivitis, current AD management, and use of topical corticosteroids (TCS) were also surveyed using a questionnaire. The prevalence of AD in university freshmen is slightly increasing from 9.1% in 2002 to 12.0% in 2010, remaining steady at around 10-11% until 2019, with poorly controlled AD present in nearly 10%. History or comorbidities of asthma and allergic rhinitis/conjunctivitis slightly increased from 2006 to 2019 in both the students with and without AD. Facial eczema was common among those with severe and most severe AD, whereas approximately 50% of the students with moderate AD and approximately 20% of those with mild AD exhibited facial eczema. The percentage of students treating AD at medical institutions and those self-managing was almost the same. This survey also revealed the presence of substantial anxiety regarding TCS use for AD and the necessity of promoting more effective explanation and education on AD by medical professionals.
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Affiliation(s)
- Takanobu Kan
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayu Kanamoto
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Morioke
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Takahagi
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Malliori S, Ntzounas A, Lampropoulos P, Koliofoti E, Priftis KN, Fouzas S, Anthracopoulos MB. Diverging trends of respiratory allergies and eczema in Greek schoolchildren: Six surveys during 1991-2018. Allergy Asthma Proc 2022; 43:e17-e24. [PMID: 34983719 DOI: 10.2500/aap.2022.43.210110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The prevalence of childhood asthma, rhinoconjunctivitis, and eczema in the city of Patras, Greece, has been followed in four consecutive surveys since 1991. After a continuous rise in the prevalence of all three of these disorders, a plateau was reached for asthma between 2003 and 2008, whereas the prevalence of rhinoconjunctivitis and eczema continued to increase. Objective: To investigate these trends in the same population into the following decade. Methods: We repeated two methodologically identical cross-sectional parental questionnaire surveys in 2013 and 2018 among 8-9-year-old schoolchildren (N = 2554 and N = 2648, respectively). In 2018, spirometry and fractional exhaled nitric oxide (FeNO) measurements were also performed. Results: Current asthma (i.e., wheeze/asthma in the past 2 years) decreased from 6.9% in 2008 to 5.2% in 2013 and 4.3% in 2018 (p for trend < 0.001). The prevalence of lifetime ("ever had") rhinoconjunctivitis also declined (5.1% in 2008, 4.4% in 2013, 3.0% in 2018; p for trend < 0.001), whereas that of lifetime eczema increased (10.8%, 13.6%, and 16.1%, respectively; p for trend < 0.001). The relative risk of current asthma in children with ever-had rhinoconjundtivitis was 7.73 in 2008, 6.00 in 2013, and 6.69 in 2018, whereas the relative risk in those with ever-had eczema was 5.15, 2.80, and 2.22, respectively. Among children with asthma, those with rhinoconjunctivitis had lower forced expiratory volume in the first second of expiration and higher FeNO values than those with eczema. Conclusion: The prevalence of asthma and rhinoconjunctivitis declined during the past decade in Greek schoolchildren, whereas the prevalence of eczema continued to rise. Nevertheless, the relationship between rhinoconjunctivitis and asthma remained strong, whereas the association between eczema and asthma appears to have weakened.
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Affiliation(s)
- Styliani Malliori
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Alexandros Ntzounas
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Panagiotis Lampropoulos
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Eleana Koliofoti
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Kostas N. Priftis
- Third Department of Paediatrics, “Attikon” Hospital, University of Athens Medical School, Athens, Greece
| | - Sotirios Fouzas
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Michael B. Anthracopoulos
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
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Ntzounas A, Giannakopoulos I, Lampropoulos P, Vervenioti A, Koliofoti EG, Malliori S, Priftis KN, Dimitriou G, Anthracopoulos MB, Fouzas S. Changing trends in the prevalence of childhood asthma over 40 years in Greece. Pediatr Pulmonol 2021; 56:3242-3249. [PMID: 34288606 DOI: 10.1002/ppul.25575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND A series of repeated questionnaire surveys among 8- to 9-year-old school children in the city of Patras, Greece, demonstrated a continuous rise in the prevalence of wheeze/asthma from 1978 to 2003, with a plateau between 2003 and 2008. We further investigated wheeze/asthma trends within the same environment over the last decade. METHODS Two follow-up surveys were conducted in 2013 (N = 2554) and 2018 (N = 2648). Physician-diagnosed wheeze and asthma were analyzed in relation to their occurrence (recent-onset: within the last 2 years; noncurrent: before 2 years; persistent: both prior and within the last 2 years). In 2018, spirometry was also performed in participants reporting symptoms and in a sample of healthy controls. RESULTS The prevalence of current wheeze/asthma declined from 6.9% in 2008% to 5.2% in 2013% and 4.3% in 2018. The persistent and noncurrent wheeze/asthma groups followed this overall trend (P-for-trend <0.001), while the prevalence of recent-onset wheeze/asthma remained unchanged (P-for-trend >0.05). Persistent and noncurrent wheezers were also more frequently diagnosed with asthma, in contrast to those with recent-onset wheeze. The FEV1 z-score was less than -1 in 32.1% of children with recent-onset and in 22.4% of those with persistent wheeze/asthma; both rates were higher than those of the Noncurrent wheeze/asthma group (7.1%; p < .05) and of healthy controls (3.5%; p < .001). CONCLUSIONS The prevalence of childhood wheeze/asthma has declined significantly during the last decade in Greece. The reversing trend may in part be attributed to changing asthma perceptions among physicians and/or parents, especially in the case of younger children with troublesome respiratory symptoms.
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Affiliation(s)
- Alexandros Ntzounas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Ioannis Giannakopoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Panagiotis Lampropoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Aggeliki Vervenioti
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Eleana-Georgia Koliofoti
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Styliani Malliori
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Kostas N Priftis
- Third Department of Pediatrics, "Attikon" Hospital and Athens University Medical School, Athens, Greece
| | - Gabriel Dimitriou
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Michael B Anthracopoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Sotirios Fouzas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
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Tu Y, Williams GM, Cortés de Waterman AM, Toelle BG, Guo Y, Denison L, Babu GR, Yang BY, Dong GH, Jalaludin B, Marks GB, Knibbs LD. A national cross-sectional study of exposure to outdoor nitrogen dioxide and aeroallergen sensitization in Australian children aged 7-11 years. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 271:116330. [PMID: 33383426 DOI: 10.1016/j.envpol.2020.116330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
The prevalence of allergic diseases in Australian children is high, but few studies have assessed the potential role of outdoor air pollution in allergic sensitization. We investigated the association between outdoor air pollution and the prevalence of aeroallergen sensitization in a national cross-sectional study of Australian children aged 7-11 years. Children were recruited from 55 participating schools in 12 Australian cities during 2007-2008. Parents completed a detailed (70-item) questionnaire. Outdoor nitrogen dioxide (NO2), as a proxy for exposure to traffic-related emissions, was estimated using measurements from regulatory monitors near each school and a national land-use regression (LUR) model. Three averaging periods were assessed, using information on duration of residence at the address, including lifetime, previous (lifetime, excluding the last year), and recent (the last year only). The LUR model was used as an additional source of recent exposure estimates at school and home addresses. Skin prick tests (SPTs) were performed to measure sensitization to eight common aeroallergens. Multilevel logistic regression estimated the association between NO2 and sensitization (by individual allergens, indoor and outdoor allergens, and all allergens combined), after adjustment for individual- and area-level covariates. In total, 2226 children had a completed questionnaire and SPT. The prevalence of sensitization to any allergen was 44.4%. Sensitization to house dust mites (HDMs) was the most common (36.1%), while sensitization to Aspergillus was the least common (3.4%). Measured mean (±s.d.) NO2 exposure was between 9 (±2.9) ppb and 9.5 (±3.2) ppb, depending on the averaging period. An IQR (4 ppb) increase in measured previous NO2 exposure was associated with greater odds of sensitization to HDMs (OR: 1.21, 95% CI: 1.01-1.43, P = 0.035). We found evidence of an association between relatively low outdoor NO2 concentrations and sensitization to HDMs, but not other aeroallergens, in Australian children aged 7-11 years.
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Affiliation(s)
- Yanhui Tu
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Gail M Williams
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | | | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, NSW, 2006, Australia; Sydney Local Health District, Sydney, NSW, 2050, Australia
| | - Yuming Guo
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia; Department of Epidemiology and Biostatistics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Lyn Denison
- ERM Services Australia, Melbourne, VIC, 3000, Australia
| | - Giridhara R Babu
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India, Bangalore, 560023, India
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bin Jalaludin
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia; Population Health, South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia; Ingham Institute, Liverpool, NSW, 2170, Australia
| | - Guy B Marks
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, 2006, Australia; South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW, 2170, Australia
| | - Luke D Knibbs
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia; Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia.
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Bosonea AM, Sharpe H, Wang T, Bakal JA, Befus AD, Svenson LW, Vliagoftis H. Developments in asthma incidence and prevalence in Alberta between 1995 and 2015. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2020; 16:87. [PMID: 33061999 PMCID: PMC7547457 DOI: 10.1186/s13223-020-00485-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/26/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Asthma is a chronic respiratory disease characterized by reversible bronchoconstriction and airway inflammation. According to Statistics Canada in 2014, 8.1% of Canadians aged 12 and older reported having asthma diagnosed by a health care professional. Therefore, in 2014 there were an estimated 274,661 persons with asthma in Alberta. Most epidemiological studies estimate prevalence and incidence using survey-based data, which has limitations. The Ontario Asthma Surveillance Information System (OASIS) group has developed and validated an algorithm for epidemiologic asthma studies using provincial health databases. In Alberta, there are some studies using provincial databases, but most are restricted to emergency department visits and do not represent the entire asthma population. Using the validated asthma definition for epidemiologic studies, we performed an analysis of the Alberta Health administrative databases to investigate and report province-wide asthma prevalence, incidence and mortality in Alberta from 1995 to 2015. METHODS Data from administrative databases, provided by Alberta Health, was analyzed to determine age and sex specific prevalence, incidence and mortality of the asthma population. The population cohort was all individuals residing in the province of Alberta, ages 0 to 99 from 1995-2015. Kendall's Tau coefficient test was used to ascertain whether the observed trends were statistically significant. RESULTS Between 1995 and 2015, the age-standardized incidence of asthma decreased by more than 50% in both males and females. Prevalence, however, increased threefold over the 20 years (for both genders) from 3.9 to 12.3% (Tau = 1.00, p < 0.0001) in females and from 3.5 to 11.6% (Tau = 1.00, p < 0.0001) in males. Thus, in 2015 there were 496,927 people with asthma in Alberta. All-cause mortality in the asthma population decreased over time, in both females (Tau = - 0.71, p < 0.0001) and males (Tau = - 0.69, p = 0.0001). For the last several years, all-cause mortality was higher in those with asthma. There were ~ 7 deaths/1000 in the population with asthma versus ~ 5 deaths/1000 in those without asthma. CONCLUSIONS The incidence of asthma decreased in both females and males while prevalence continued to increase, although at a slower rate than previously. All-cause mortality in asthma patients was higher than in those without asthma, but both decreased over time.
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Affiliation(s)
- Ana-Maria Bosonea
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 11350 83rd Ave, 3-134b Clinical Sciences Building, Edmonton, AB T6G 2G3 Canada
- Clinical Allergy and Immunology, University of British Columbia, Vancouver, Canada
| | - Heather Sharpe
- Respiratory Health Strategic Clinical Network (RHSCN), Alberta Health Services (AHS), Edmonton, Canada
| | - Ting Wang
- Provincial Research Data Services-Alberta Health Services, Edmonton, Canada
| | - Jeffrey A Bakal
- Provincial Research Data Services-Alberta Health Services, Edmonton, Canada
| | - A Dean Befus
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 11350 83rd Ave, 3-134b Clinical Sciences Building, Edmonton, AB T6G 2G3 Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, Canada
| | - Lawrence W Svenson
- Analytics & Performance Reporting Branch, Alberta Health, Edmonton, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Harissios Vliagoftis
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 11350 83rd Ave, 3-134b Clinical Sciences Building, Edmonton, AB T6G 2G3 Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, Canada
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He Y, Stephenson M, Gu Y, Hu X, Zhang M, Jin J. Asthma self-management in children: a best practice implementation project. ACTA ACUST UNITED AC 2020; 17:985-1002. [PMID: 31090653 DOI: 10.11124/jbisrir-2017-003775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Asthma is one of the most common diseases in children. A self-management program can effectively improve the outcomes for children with asthma and reduce the burden on healthcare services. OBJECTIVES The aim of this project was to integrate the best evidence on asthma self-management with practice in a children's respiratory clinic and to improve compliance with best practice. METHODS Seven audit criteria were developed for the pre- and post-audit based on the best available evidence. The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools were used in this project. RESULTS The baseline audit showed a gap between clinical practice and the best evidence. The only criterion that achieved high compliance was provision of inhaler guidance (100%). After implementation, there were substantial improvements in compliance for many criteria. Training of clinicians increased from 13% at baseline to 67% at follow-up. Education of parents improved, with specific education about asthma triggers increasing from 55% to 100%, education about warning signs from 30% to 85% and education about effective asthma treatment options from 40% to 85%. Use of written asthma action plans increased from 0% to 25%. CONCLUSION Strategies developed in this project were effective at providing necessary information for parents and improved the compliance with evidence. Further implementation strategies and audits are still needed to improve the use of asthma action plans and ensure they are reviewed periodically.
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Affiliation(s)
- Yingxia He
- Children's Hospital of Fudan University, Shanghai, People's Republic of China.,Fudan University Centre for Evidence-based Nursing: a Joanna Briggs Institute Centre of Excellence
| | - Matthew Stephenson
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Ying Gu
- Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xiaojing Hu
- Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Mingzhi Zhang
- Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jie Jin
- Children's Hospital of Fudan University, Shanghai, People's Republic of China
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Leth‐Møller KB, Skaaby T, Linneberg A. Allergic rhinitis and allergic sensitisation are still increasing among Danish adults. Allergy 2020; 75:660-668. [PMID: 31512253 DOI: 10.1111/all.14046] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Only a limited number of studies have included objective measures of allergic sensitisation (such as skin-prick test [SPT] and serum specific IgE [sIgE]) when studying time trends in allergic respiratory disease in adults within the current millennium. METHODS Five health examination studies of random samples of individuals aged 18-69 years resident in the Copenhagen region were conducted in 1990-1991, 2006-2008, 2010-2011, 2012-2015, and 2016-2017. Allergic sensitisation was defined by sIgE (in 1990-1991, 2006-2008, and, 2012-2015) or SPT (in 2006-2008, 2010-2011, and 2016-2017) to at least one of the allergens: birch, grass, house dust mite, or cat. Allergic rhinitis was defined as sensitisation and self-reported nasal symptoms. RESULTS The age- and sex-standardised prevalence of sIgE-defined sensitisation increased from 16% in 1990-1991, to 26% in 2006-2008, and to 29% in 2012-2015. The age- and sex-standardised prevalence of SPT-defined sensitisation increased from 27% in 2006-2008, to 28% in 2010-2011, and to 32% in 2016-2017. Changes in sIgE-defined and SPT-defined allergic rhinitis showed similar increasing trends. CONCLUSION The prevalence of allergic sensitisation and allergic rhinitis increased in a general adult Danish population over the last three decades and has thus continued to increase in the current millennium.
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Affiliation(s)
- Katja Biering Leth‐Møller
- Center for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital Frederiksberg Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- ALK‐Abelló A/S Hørsholm Denmark
| | - Tea Skaaby
- Center for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital Frederiksberg Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital Frederiksberg Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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10
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Nwaru BI, Ekerljung L, Rådinger M, Bjerg A, Mincheva R, Malmhäll C, Axelsson M, Wennergren G, Lotvall J, Lundbäck B. Cohort profile: the West Sweden Asthma Study (WSAS): a multidisciplinary population-based longitudinal study of asthma, allergy and respiratory conditions in adults. BMJ Open 2019; 9:e027808. [PMID: 31221886 PMCID: PMC6589027 DOI: 10.1136/bmjopen-2018-027808] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The West Sweden Asthma Study (WSAS) is a population-representative longitudinal study established to: (1) generate data on prevalence trends, incidence and remission of asthma, allergy and respiratory conditions, (2) elucidate on the risk and prognostic factors associated with these diseases, (3) characterise clinically relevant phenotypes of these diseases and (4) catalyse relevant mechanistic, genomic, genetic and translational investigations. PARTICIPANTS WSAS comprised of randomly selected individuals aged 16 to 75 years who are followed up longitudinally. The first stage involved a questionnaire survey (>42 000 participants) and was undertaken in 2008 and 2016. A random sample (about 8000) of participants in the initial survey undergoes extensive clinical investigations every 8 to 10 years (first investigations in 2009 to 2012, second wave currently ongoing). Measurements undertaken at the clinical investigations involve structured interviews, self-completed questionnaire on personality traits, physical measurements and extensive biological samples. FINDINGS TO DATE Some of our key findings have shown a 54% increase in the use of asthma medications between the 1990s and 2000s, primarily driven by a five-fold increase in the use of inhaled corticosteroids. About 36% of asthmatics expressed at least one sign of severe asthma indicator, with differential lung performance, inflammation and allergic sensitisation among asthmatics with different signs of severe asthma. Multi-symptom asthmatics were at greater risk of having indicators of severe asthma. In all adults, being raised on a farm was associated with a decreased risk of allergic sensitisation, rhinitis and eczema, but not asthma. However, among adolescents (ie, those 16 to 20 years of age), being raised on a farm decreased the risk of asthma. Personality traits were associated with both beliefs of asthma medication and adherence to treatment. FUTURE PLANS Follow-up of the cohort is being undertaken every 8 to 10 years. The repeated clinical examinations will take place in 2019 to 2022. The cohort data are currently being linked to routine Swedish healthcare registers for a continuous follow-up. Mechanistic, genomic, genetic and translational investigations are ongoing.
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Affiliation(s)
- Bright I Nwaru
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Linda Ekerljung
- University of Gothenburg, Krefting Research Centre, Medicinaregatan, Sweden
| | | | - Anders Bjerg
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Roxana Mincheva
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Carina Malmhäll
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Göran Wennergren
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | | | - Bo Lundbäck
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
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11
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Knibbs LD, Cortés de Waterman AM, Toelle BG, Guo Y, Denison L, Jalaludin B, Marks GB, Williams GM. The Australian Child Health and Air Pollution Study (ACHAPS): A national population-based cross-sectional study of long-term exposure to outdoor air pollution, asthma, and lung function. ENVIRONMENT INTERNATIONAL 2018; 120:394-403. [PMID: 30125857 DOI: 10.1016/j.envint.2018.08.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
Most studies of long-term air pollution exposure and children's respiratory health have been performed in urban locations with moderate pollution levels. We assessed the effect of outdoor nitrogen dioxide (NO2), as a proxy for urban air pollution, on current asthma and lung function in Australia, a low-pollution setting. We undertook a national population-based cross-sectional study of children aged 7-11 years living in 12 Australian cities. We collected information on asthma symptoms from parents via questionnaire and measured children's lung function (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC]) and fractional exhaled nitric oxide [FeNO]). We estimated recent NO2 exposure (last 12 months) using monitors near each child's school, and used a satellite-based land-use regression (LUR) model to estimate NO2 at each child's school and home. Our analysis comprised 2630 children, among whom the prevalence of current asthma was 14.9%. Mean (±SD) NO2 exposure was 8.8 ppb (±3.2) and 8.8 ppb (±2.3) for monitor- and LUR-based estimates, respectively. Mean percent predicted post-bronchodilator FEV1 and FVC were 101.7% (±10.5) and 98.8% (±10.5), respectively. The geometric mean FeNO concentration was 9.4 ppb (±7.1). An IQR increase in NO2 (4.0 ppb) was significantly associated with increased odds of having current asthma; odds ratios (ORs) were 1.24 (95% CI: 1.08, 1.43) and 1.54 (95% CI: 1.26, 1.87) for monitor- and LUR-based estimates, respectively. Increased NO2 exposure was significantly associated with decreased percent predicted FEV1 (-1.35 percentage points [95% CI: -2.21, -0.49]) and FVC (-1.19 percentage points [95% CI: -2.04, -0.35], and an increase in FeNO of 71% (95% CI: 38%, 112%). Exposure to outdoor NO2 was associated with adverse respiratory health effects in this population-based sample of Australian children. The relatively low NO2 levels at which these effects were observed highlight the potential benefits of continuous exposure reduction.
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Affiliation(s)
- Luke D Knibbs
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia.
| | | | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia; Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Yuming Guo
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; Department of Epidemiology and Biostatistics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Lyn Denison
- ERM Services Australia, Melbourne, VIC 3000, Australia
| | - Bin Jalaludin
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; Population Health, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia; Ingham Institute, Liverpool, NSW 2170, Australia
| | - Guy B Marks
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia; South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW 2170, Australia
| | - Gail M Williams
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
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12
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Clifford S, Mazaheri M, Salimi F, Ezz WN, Yeganeh B, Low-Choy S, Walker K, Mengersen K, Marks GB, Morawska L. Effects of exposure to ambient ultrafine particles on respiratory health and systemic inflammation in children. ENVIRONMENT INTERNATIONAL 2018. [PMID: 29514111 DOI: 10.1016/j.envint.2018.02.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
It is known that ultrafine particles (UFP, particles smaller than 0.1 μm) can penetrate deep into the lungs and potentially have adverse health effects. However, epidemiological data on the health effects of UFP is limited. Therefore, our objective was to test the hypothesis that exposure to UFPs is associated with respiratory health status and systemic inflammation among children aged 8 to 11 years. We conducted a cross-sectional study among 655 children (43.3% male) attending 25 primary (elementary) schools in the Brisbane Metropolitan Area, Australia. Ultrafine particle number concentration (PNC) was measured at each school and modelled at homes using Land Use Regression to derive exposure estimates. Health outcomes were respiratory symptoms and diagnoses, measured by parent-completed questionnaire, spirometric lung function, exhaled nitric oxide (FeNO), and serum C reactive protein (CRP). Exposure-response models, adjusted for potential personal and environmental confounders measured at the individual, home and school level, were fitted using Bayesian methods. PNC was not independently associated with respiratory symptoms, asthma diagnosis or spirometric lung function. However, PNC was positively associated with an increase in CRP (1.188-fold change per 1000 UFP cm-3 day/day (95% credible interval 1.077 to 1.299)) and an increase in FeNO among atopic participants (1.054 fold change per 1000 UFP cm-3 day/day (95% CrI 1.005 to 1.106)). UFPs do not affect respiratory health outcomes in children but do have systemic effects, detected here in the form of a positive association with a biomarker for systemic inflammation. This is consistent with the known propensity of UFPs to penetrate deep into the lung and circulatory system.
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Affiliation(s)
- Sam Clifford
- International Laboratory for Air Quality and Health, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia; ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
| | - Mandana Mazaheri
- International Laboratory for Air Quality and Health, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Farhad Salimi
- University Centre for Rural Health - North Coast, School of Public Health, University of Sydney, Australia; Menzies Institute for Medical Research, University of Tasmania, Australia; Centre for Air quality and health Research and evaluation (NHMRC Centre of Research Excellence), Australia
| | - Wafaa Nabil Ezz
- Woolcock Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Bijan Yeganeh
- International Laboratory for Air Quality and Health, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Air quality and health Research and evaluation (NHMRC Centre of Research Excellence), Australia
| | - Samantha Low-Choy
- Griffith Social & Behavioural Research College, Griffith University, Mt Gravatt, Queensland, Australia
| | | | - Kerrie Mengersen
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia; ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
| | - Guy B Marks
- Centre for Air quality and health Research and evaluation (NHMRC Centre of Research Excellence), Australia; Woolcock Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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13
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Guo X, Li Z, Ling W, Long J, Su C, Li J, Liang S, Su L. Epidemiology of childhood asthma in mainland China (1988-2014): A meta-analysis. Allergy Asthma Proc 2018; 39:15-29. [PMID: 29669661 PMCID: PMC5911512 DOI: 10.2500/aap.2018.39.4131] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND After the promotion of the two-child policy in recent years, the population of children in mainland China was bound to have a rapid growth, which would bring great challenges to public health. A number of cross-sectional studies on the epidemic of childhood asthma in mainland China were recently conducted, and varied prevalences were reported. Thus, knowing the epidemiology of childhood asthma in mainland China is of great necessity. OBJECTIVE Our study aimed to summarize the pooled prevalence of childhood asthma in mainland China and its time trend, gender difference, regional distribution, and age structure. METHODS Studies that reported the prevalence of childhood asthma in mainland China were identified via a systematic data base search through July 1, 2016. Meta-analysis was used to estimate the prevalence of childhood asthma and its subgroups, including gender, age groups, years, and regions. The regional distribution of the prevalence was set by province with the help of a geographic mapping software. The autoregressive integrated moving average model was used to predict the current prevalence of asthma. RESULTS A total of 117 studies published from 1988 to 2014 in mainland China with a total sample size of 2,678,696 were included. The overall current prevalence and lifetime prevalence of childhood asthma was 2.112% (95% confidence interval [CI], 1.977-2.247%) and 2.502% (95% CI, 2.166-2.838%), respectively. The difference of the prevalences between male and female patients was significant: odds ratio 1.54 (95% CI, 1.47-1.62) for the current prevalence and odds ratio 1.61 (95% CI, 1.47-1.77) for the lifetime prevalence. CONCLUSION The prevalence of childhood asthma in mainland China was low but has been increasing remarkably since 1998. Boys are more likely to have asthma throughout most of their childhood. Preschoolers (3-6 years old) showed a higher prevalence than the other age groups. The current prevalence of childhood asthma probably increased slightly from 2017 to 2019.
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Affiliation(s)
- Xiaojing Guo
- From the Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China, and
| | - Zhuoying Li
- From the Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China, and
| | - Weijun Ling
- From the Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China, and
| | - Jianxiong Long
- From the Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China, and
| | - Cuilin Su
- From the Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China, and
| | - Jinglin Li
- From the Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China, and
| | - Siqiao Liang
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Li Su
- From the Department of Epidemiology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China, and
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14
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Koet LBM, Brand PLP. Increase in atopic sensitization rate among Dutch children with symptoms of allergic disease between 1994 and 2014. Pediatr Allergy Immunol 2018; 29:78-83. [PMID: 29047176 DOI: 10.1111/pai.12825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of symptoms of allergic diseases has increased significantly during the last decades. However, studies into time trends of atopic sensitization among children are limited and have focused on aeroallergen sensitization. We aimed to investigate time trends in the prevalence and degree of atopic sensitization to inhalant and food allergens among children (0-17 years) with symptoms of allergic disease. METHODS Sensitization data of all children tested in our clinical laboratory during 1994-2014 were analyzed. Sensitization was detected using the ImmunoCAP system and defined as a specific IgE level of ≥0.35 kU/L. Trends in sensitization rates to 5 food and 5 aeroallergens for different age categories were investigated with logistic regression, adjusted for age and sex. RESULTS Sensitization data of 18 199 children were analyzed. Between 1994 and 2014, a steady and statistically significant increase in overall sensitization rate was found (from 40.5% in 1994 to 48.9% in 2014, adjusted odds ratio [aOR] 1.01 per year, 95% confidence interval [CI] 1.00 to 1.01, P = .003). This increase in sensitization rate was mainly explained by increasing aeroallergen sensitization among 4- to 11-year-old children (aOR 1.02, 95% CI 1.01 to 1.02, P < .001). We found no increase in sensitization rates to food and aeroallergens in other age categories. The degree of sensitization did not change significantly during the study period (all tests P > .15). CONCLUSION We observed a statistically significant increase in sensitization rate between 1994 and 2014 among children with symptoms of allergic disease. This was mainly explained by increasing aeroallergen sensitization among 4- to 11-year-olds.
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Affiliation(s)
- Lukas B M Koet
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands
| | - Paul L P Brand
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands.,UMCG Postgraduate School of Medicine, Wenckebach Institute, University Medical Centre Groningen, Groningen, The Netherlands
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15
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Bunne J, Moberg H, Hedman L, Andersson M, Bjerg A, Lundbäck B, Rönmark E. Increase in Allergic Sensitization in Schoolchildren: Two Cohorts Compared 10 Years Apart. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:457-463.e1. [PMID: 27838328 DOI: 10.1016/j.jaip.2016.09.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/01/2016] [Accepted: 09/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Time trends of incidence of allergic sensitization are unknown and recent trends of prevalence and risk factors are lacking. OBJECTIVE To estimate the incidence, prevalence, remission, risk factors, and time trends for allergic sensitization among schoolchildren followed from age 7 to 8 years to age 11 to 12 years. METHODS In 2006, all children in grades 1 and 2 aged 7 to 8 years in 2 municipalities in northern Sweden were invited to a questionnaire survey and to skin prick testing to 10 common airborne allergens. The cohort was reexamined in 2010, with additional blood sampling for specific IgE. Participation rates were 90% (n = 1700) at age 7 to 8 years and 85% (n = 1657) at age 11 to 12 years. The results were compared with a cohort examined by identical methods 10 years earlier. RESULTS The prevalence of positive skin prick test result to any allergen increased from 30% at age 7 to 8 years to 41% at age 11 to 12 years (P < .001). The cumulative 4-year incidence was 18%, while remission was low. Sensitization to pollen and furred animals was most common. A family history of allergy was significantly associated with incident sensitization, whereas the presence of furred animals at home was negatively associated. The prevalence at age 7 to 8 years and at age 11 to 12 years and the 4-year incidence were all significantly higher compared with the cohort examined 10 years earlier. CONCLUSIONS The prevalence of allergic sensitization increased by age as a consequence of a high incidence and a low remission. The trends of increasing incidence and prevalence among schoolchildren imply future increases in the prevalence of allergic diseases.
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Affiliation(s)
- Joakim Bunne
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Helena Moberg
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden; Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
| | - Anders Bjerg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden.
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16
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Mirzaei M, Karimi M, Beheshti S, Mohammadi M. Prevalence of asthma among Middle Eastern children: A systematic review. Med J Islam Repub Iran 2016. [PMID: 28638816 PMCID: PMC5473014 DOI: 10.18869/mjiri.31.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: The prevalence of asthma and allergy has increased during the last decades, especially in children. However, little is known about it in the Middle East region. This systematic review is aimed to estimate the prevalence of asthma among the Middle Eastern children.
Methods: Local and international scientific databases including SID, Iranmedex, Medline and Science Direct were systematically searched for relevant keywords including; asthma, prevalence, children, International Study of Asthma and Allergies in Childhood (ISACC) and the names of Middle Eastern countries for the period of 1996-2011. Papers in Persian and English which met the defined criteria were included into the study. Bibliographies of the extracted articles were also searched. After extraction of data, heterogeneity between studies and publication bias were measured using Egger's-test. Effect size was pooled by the random-effect model. Since significant heterogeneity was found between studies, univariate meta-regression analyses were done to assess the association of variables with the overall results.
Results: Fifty studies in the Middle East examined the prevalence of asthma and allergy in children under the age of 18 years according to the ISAAC criteria and were included. A total number of 289,717 children were examined in the included studies and the prevalence varied from 0.7 % in Isfahan to 22.3 % in Bagdad. The total prevalence of diagnosed asthma was calculated 7.53 % (95% Cl: 6.38-8.75). Prevalence of asthma in the 13-14 years age group was 7.57% (95% Cl: 5.78-9.29) and in 6-7 years age group was 7.43% (95% Cl: 5.75-9.10). The prevalence of asthma among girls, based on random effect model, was 6.30% (95% Cl: 4.97-7.61) and among boys, it was 8.91% (95% Cl: 6.80-11.04).
Conclusion: The prevalence of asthma in the Middle East is lower than most developed countries. However, there is not enough longitudinal data to estimate the trend over time. In order to have more accurate estimates and to provide evidence for proper planning, standard epidemiologic studies should be conducted in countries of the region.
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Affiliation(s)
- Masoud Mirzaei
- Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehran Karimi
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Shima Beheshti
- Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Masoud Mohammadi
- Department of Social Medicine, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Riiser A. Bronchial hyperresponsiveness in childhood: A narrative review. World J Respirol 2016; 6:63-68. [DOI: 10.5320/wjr.v6.i2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/02/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
Bronchial hyperresponsiveness (BHR) is an important but not asthma-specific characteristic and can be assessed by direct and indirect methods, based on the stimulus causing airway obstruction. BHR has been proposed as a prognostic marker of asthma severity and persistence, and may also be used to control pharmacological management of asthma. The most recent data on the prevalence and development of BHR in childhood and its predictive value for subsequent asthma development in late adolescence and adulthood is discussed in this review. According to the BHR-related scientific articles written in the English language and indexed in the publicly searchable PubMed database, the prevalence of BHR varies based upon the methods used to assess it and the population examined. In general, however, BHR prevalence is reduced as children grow older, in both healthy and asthmatic populations. While asthma can be predicted by BHR, the predictive value is limited. Reduced lung function, allergic sensitization, female sex, and early respiratory illness have been identified as risk factors for BHR. The collective studies further indicate that BHR is a dynamic feature related to asthma, but asymptomatic BHR is also common. Ultimately, the prevalence of BHR varies depending on the population, the environment, and the evaluation methods used. While both the methacholine challenge and the exercise test may predict asthma in adolescence or early adulthood, the predictive value is higher for the methacholine challenge compared to the exercise test. The collective data presented in the present study demonstrate how BHR develops through childhood and its relation to bronchial asthma.
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18
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Bjerg A, Ekerljung L, Eriksson J, Näslund J, Sjölander S, Rönmark E, Dahl Å, Holmberg K, Wennergren G, Torén K, Borres MP, Lötvall J, Lundbäck B. Increase in pollen sensitization in Swedish adults and protective effect of keeping animals in childhood. Clin Exp Allergy 2016; 46:1328-36. [PMID: 27159904 DOI: 10.1111/cea.12757] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND To date, most studies of the 'allergy epidemic' have been based on self-reported data. There is still limited knowledge on time trends in allergic sensitization, especially among adults. OBJECTIVE To study allergic sensitization, its risk factors and time trends in prevalence. METHODS Within West Sweden Asthma Study (WSAS), a population-based sample of 788 adults (17-60 years) underwent skin prick tests (SPTs) for 11 aeroallergens 2009-2012. Specific IgE was analysed in 750 of the participants. Those aged 20-46 years (n = 379) were compared with the European Community Respiratory Health Survey sample aged 20-46 year from the same area (n = 591) in 1991-1992. RESULTS Among those aged 20-46 years, the prevalence of positive SPT to pollen increased, timothy from 17.1% to 29.0% (P < 0.001) and birch from 15.6% to 23.7% (P = 0.002) between 1991-1992 and 2009-2012. Measurements of specific IgE confirmed these increases. Prevalence of sensitization to all other tested allergens was unchanged. In the full WSAS sample aged 17-60 years, any positive SPT was seen in 41.9%, and the dominating sensitizers were pollen (34.3%), animals (22.8%) and mites (12.6%). Pollen sensitization was strongly associated with rhinitis, whereas indoor allergens were more associated with asthma. Growing up with livestock or furred pets decreased the risk of sensitization, adjusted odds ratio 0.53 (0.28-0.995) and 0.68 (0.47-0.98), respectively. CONCLUSION Pollen sensitization has increased in Swedish adults since the early 1990s, while the prevalence of sensitization to other allergens has remained unchanged. This is one plausible explanation for the increase in rhinitis 1990-2008 in Swedish adults, during which time the prevalence of asthma, which is more associated with perennial allergens, was stable. Contact with animals in childhood seems to reduce the risk of sensitization well into adulthood. One major factor contributing to the rise in pollen allergy is a significant increase in levels of birch and grass pollen over the past three decades.
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Affiliation(s)
- A Bjerg
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden. .,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - L Ekerljung
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden
| | - J Eriksson
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden
| | - J Näslund
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden
| | - S Sjölander
- ImmunoDiagnostics, ThermoFisher Scientific, Uppsala, Sweden
| | - E Rönmark
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden.,Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, the OLIN Unit, Umeå, Sweden
| | - Å Dahl
- Department of Biological and Environmental Sciences, University of Gothenburg, Göteborg, Sweden
| | - K Holmberg
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - G Wennergren
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden.,Department of Pediatrics, Gothenburg University, Gothenburg, Sweden
| | - K Torén
- Department of Public Health and Community Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - M P Borres
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - J Lötvall
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden
| | - B Lundbäck
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Gothenburg University, Göteborg, Sweden
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19
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Lundbäck B, Backman H, Lötvall J, Rönmark E. Is asthma prevalence still increasing? Expert Rev Respir Med 2015; 10:39-51. [DOI: 10.1586/17476348.2016.1114417] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bjerg A, Hedman L, Perzanowski M, Wennergren G, Lundbäck B, Rönmark E. Decreased importance of environmental risk factors for childhood asthma from 1996 to 2006. Clin Exp Allergy 2015; 45:146-53. [PMID: 25323476 DOI: 10.1111/cea.12439] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 07/23/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The large increase in asthma prevalence continues in several, but not all areas. Despite the individual risk factors that have been identified, the reasons for the observed trends in prevalence are largely unknown. OBJECTIVE This study sought to characterize what trends in risk factors accompanied trends in asthma prevalence. METHODS Two population-based cohorts of 7- to 8-year-old children from the same Swedish study areas examined by expanded International Study of Asthma and Allergy in Childhood questionnaires were compared 10 years apart. In 1996 and 2006, 3430 (97% participation) and 2585 (96% participation) questionnaires were completed, respectively. A subset was skin-prick-tested: in 1996 and 2006, 2148 (88% participation) and 1700 (90% participation) children, respectively. The adjusted population-attributable fraction (aPAF) was calculated using the prevalence and multivariate odds ratio of each risk factor. RESULTS The prevalence of current asthma and wheeze was similar in 1996 and 2006. Allergic sensitization, however, increased from 21% to 30%. The prevalence of parental asthma increased from 17% to 24%, while respiratory infections and maternal smoking decreased (60% to 29% and 32% to 16%, respectively). The aPAFs of non-environmental risk factors for current asthma increased in 1996-2006: allergic sensitization from 35% to 41%, parental asthma from 27% to 45% and male sex from 20% to 25%. Conversely, the aPAFs of environmental risk factors decreased: respiratory infections from 36% to 32% and damp home and maternal smoking from 14% and 19%, respectively, to near zero in 2006. CONCLUSIONS AND CLINICAL RELEVANCE From 1996 to 2006, the non-environmental risk factors parental asthma, allergic sensitization and male sex had an increasing or constant importance for current asthma in 7- to 8-year-old children. The importance of the environmental exposures damp home, respiratory infections and maternal smoking decreased. This counterbalancing in risk factors may explain the level of prevalence of current asthma.
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Affiliation(s)
- A Bjerg
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, the OLIN Unit, Umeå University, Umeå, Sweden
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Zhu WJ, Ma HX, Cui HY, Lu X, Shao MJ, Li S, Luo YQ, Wang Q, Xu CY, Xu DQ, Liu CH, Chen YZ. Prevalence and Treatment of Children's Asthma in Rural Areas Compared with Urban Areas in Beijing. Chin Med J (Engl) 2015; 128:2273-7. [PMID: 26315071 PMCID: PMC4733796 DOI: 10.4103/0366-6999.163381] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The prevalence of childhood asthma has been increasing in China. This study aimed to compare the prevalence, diagnosis, and treatment of asthmatic children from urban and rural areas in Beijing, China. METHODS Schools, communities, and kindergartens were randomly selected by cluster random sampling from urban and rural areas in Beijing. Parents were surveyed by the same screening questionnaires. On-the-spot inquiries, physical examinations, medical records, and previous test results were used to diagnose asthmatic children. Information on previous diagnoses, treatments, and control of symptoms was obtained. RESULTS From 7209 children in rural areas and 13,513 children in urban areas who completed screening questionnaires, 587 children were diagnosed as asthma. The prevalence of asthma in rural areas was lower than in urban areas (1.25% vs. 3.68%, χ2 = 100.80, P < 0.001). The diagnosis of asthma in rural areas was lower than in urban areas (48.9% vs. 73.9%, χ2 = 34.6, P < 0.001). Compared with urban asthmatic children (56.5%), only 35.6% of rural asthmatic children received inhaled corticosteroids (P < 0.05). The use of bronchodilators was also lower in rural areas than in urban areas (56.5% vs. 66.4%, χ2 = 14.2, P < 0.01). CONCLUSION The prevalence of asthma in children was lower in rural areas compared with children in the urban area of Beijing. A considerable number of children were not diagnosed and inadequately treated in rural areas.
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Affiliation(s)
- Wen-Jing Zhu
- Center for Asthma Prevention and Education, Capital Institute of Pediatrics, Beijing 100020, China
| | - Hai-Xia Ma
- Department of Pediatrics, Liangxiang Hospital, Fangshan District, Beijing 102401, China
| | - Hui-Ying Cui
- Department of Pediatrics, Tongzhou Maternal and Child Health Hospital, Beijing 101199, China
| | - Xu Lu
- Department of Pediatrics, Tongzhou Maternal and Child Health Hospital, Beijing 101199, China
| | - Ming-Jun Shao
- Center for Asthma Prevention and Education, Capital Institute of Pediatrics, Beijing 100020, China
| | - Shuo Li
- Center for Asthma Prevention and Education, Capital Institute of Pediatrics, Beijing 100020, China
| | - Yan-Qing Luo
- Center for Asthma Prevention and Education, Capital Institute of Pediatrics, Beijing 100020, China
| | - Qiang Wang
- Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chun-Yu Xu
- Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Dong-Qun Xu
- Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chuan-He Liu
- Center for Asthma Prevention and Education, Capital Institute of Pediatrics, Beijing 100020, China
| | - Yu-Zhi Chen
- Center for Asthma Prevention and Education, Capital Institute of Pediatrics, Beijing 100020, China
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de Korte-de Boer D, Mommers M, Gielkens-Sijstermans CML, Creemers HMH, Feron FJM, van Schayck OCP. Trends in wheeze in Dutch school children and the role of medication use. Pediatr Pulmonol 2015; 50:665-71. [PMID: 24995931 DOI: 10.1002/ppul.23077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 05/09/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND While the prevalence of childhood wheeze continues to increase in many countries, decreasing trends have also been reported. This may be explained by increased use of asthma medication, which effectively suppresses wheeze symptoms. In this study we investigated trends in wheeze in Dutch school children between 1989 and 2005, and their association with medication use. METHODS In five repeated cross-sectional surveys between 1989 and 2005, parents of all 5- to 6-year-old and 8- to 11-year-old children eligible for a routine physical examination were asked to complete a questionnaire on their child's respiratory health. We identified all children for whom a questionnaire was completed in two successive surveys. Children were grouped according to birth year and classified into one out of four wheeze categories: "no wheeze," "discontinued wheeze," "continued wheeze," or "new-onset wheeze." RESULTS In total, 3,339 children, born in 1983 (N = 670), 1988 (N = 607), 1992 (N = 980), and 1995 (N = 1,082), participated twice. Over the study period, the proportion of children with "no wheeze" increased from 73.8% to 86.1% (Ptrend < 0.001), while the proportion of children with "discontinued" and "continued" wheeze decreased from 13.2% to 6.3% (Ptrend < 0.001) and from 8.8% to 3.1% (Ptrend < 0.001), respectively. Medication use was consistently associated only with the presence of wheeze symptoms and this association did not change over time (Pbirth year × medication use > 0.05 for all wheeze categories). CONCLUSION An increasing trend of Dutch school children with "no wheeze," and decreasing trends of children with "discontinued" and "continued" wheeze between 1989 and 2005 could not be explained by (increased) medication use. This suggests that wheeze prevalence is not masked by medication use, but is truly declining.
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Affiliation(s)
- Dianne de Korte-de Boer
- Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands
| | - Monique Mommers
- Department of Epidemiology, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands
| | | | | | - Frans J M Feron
- Department of Social Medicine, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands
| | - Onno C P van Schayck
- Department of General Practice, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands
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Barnish MS, Tagiyeva N, Devereux G, Aucott L, Turner S. Diverging prevalences and different risk factors for childhood asthma and eczema: a cross-sectional study. BMJ Open 2015; 5:e008446. [PMID: 26059525 PMCID: PMC4466692 DOI: 10.1136/bmjopen-2015-008446] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To compare the prevalences of and risk factors for asthma, wheeze, hay fever and eczema in primary schoolchildren in Aberdeen in 2014. DESIGN Cross-sectional survey. SETTING Primary schools in Aberdeen, North-East Scotland. PARTICIPANTS Children in Scottish school years primary 1-7 were handed a questionnaire by their class teacher to be completed by their parents and returned to the researchers by post or online. MAIN OUTCOME MEASURES Lifetime history of asthma, eczema and hay fever, and recent history of wheeze. RESULTS 41 schools agreed to participate (87%). 11,249 questionnaires were distributed and 3935 returned (35%). A parent-reported lifetime history of asthma, eczema and hay fever was present in 14%, 30% and 24% of children, respectively. The odds of lifetime asthma increased with age (OR 1.1 per year, 95% CI 1.1 to 1.2), male sex (OR 1.89, 95% CI 1.4 to 2.3), parental smoking (OR 1.7, 95% CI 1.2 to 2.3) and eczema (OR 6.6, 95% CI 5.2 to 8.4). Prevalence of recent wheeze was also reported to be 14% and was positively associated with male sex, parental smoking and eczema. In contrast, parental eczema was the only identified predictor of childhood eczema risk. CONCLUSIONS The lifetime prevalence of asthma in primary schoolchildren was 14% in this survey, approximately half the prevalence of eczema. We report diverging prevalences in relation to previous studies in our locality, and different risk factors for asthma and eczema. These findings suggest that asthma and eczema are unlikely to have a common origin.
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Affiliation(s)
- Maxwell S Barnish
- Epidemiology Group, University of Aberdeen, Aberdeen, UK
- Child Health, University of Aberdeen, Aberdeen, UK
| | | | | | - Lorna Aucott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
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Engelkes M, Janssens HM, de Ridder MAJ, de Jongste JC, Sturkenboom MCJM, Verhamme KMC. Time trends in the incidence, prevalence and age at diagnosis of asthma in children. Pediatr Allergy Immunol 2015; 26:367-74. [PMID: 25827225 DOI: 10.1111/pai.12376] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current knowledge on the prevalence of asthma is mainly based on cross-sectional questionnaire data. Current population-based data on the incidence of asthma in children are scarce. OBJECTIVE To study the incidence, prevalence, and age at diagnosis of asthma in children in the Netherlands over the study period 2000-2012. METHODS A population-based cohort study was conducted in the Integrated Primary Care Information database. The cohort consisted of 176,516 children (379,536 personyears (PY) of follow-up), aged 5-18 years between 2000 and 2012. All medical records of children with physician diagnosed asthma were validated. Incidence rates, annual percent change (APC), and prevalence for asthma were calculated. Influence of age and gender on incidence rates and change in age at diagnosis were studied. RESULTS We identified an asthma cohort of 14,303 children with 35,118 PY. The overall incidence rate was 6.7/1000 PY (95% CI, 6.45-6.97). Until 2008, the incidence rate was significantly increasing (APC 5.79 (95% CI 1.43-10.34); from 2008 onwards, a non-significant decrease was observed (APC -12.16 (95% CI -23.07 to 0.28). Incidence for girls was lower than for boys, this difference decreased with increasing age. (p < 0.001) Overall, the age at diagnosis increased over calendar time and was lower for boys. (linear trend p < 0.001). CONCLUSION Our population-based cohort study observed an incidence rate of 6.7 per 1000 PY of physician-diagnosed asthma in children in the Netherlands over 2000-2012. The asthma incidence rate was increasing until 2008. Further studies are needed to confirm the decrease in asthma incidence rate from 2008 onwards.
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Affiliation(s)
- Marjolein Engelkes
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands
| | - Hettie M Janssens
- Department of Pediatrics, Division Respiratory Medicine and Allergology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Johan C de Jongste
- Department of Pediatrics, Division Respiratory Medicine and Allergology, Erasmus MC, Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands
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Ezz WN, Mazaheri M, Robinson P, Johnson GR, Clifford S, He C, Morawska L, Marks GB. Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) in Brisbane, Queensland (Australia): study design and implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1687-702. [PMID: 25648226 PMCID: PMC4344688 DOI: 10.3390/ijerph120201687] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 01/13/2015] [Indexed: 01/17/2023]
Abstract
Ultrafine particles are particles that are less than 0.1 micrometres (µm) in diameter. Due to their very small size they can penetrate deep into the lungs, and potentially cause more damage than larger particles. The Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) study is the first Australian epidemiological study to assess the health effects of ultrafine particles on children's health in general and peripheral airways in particular. The study is being conducted in Brisbane, Australia. Continuous indoor and outdoor air pollution monitoring was conducted within each of the twenty five participating school campuses to measure particulate matter, including in the ultrafine size range, and gases. Respiratory health effects were evaluated by conducting the following tests on participating children at each school: spirometry, forced oscillation technique (FOT) and multiple breath nitrogen washout test (MBNW) (to assess airway function), fraction of exhaled nitric oxide (FeNO, to assess airway inflammation), blood cotinine levels (to assess exposure to second-hand tobacco smoke), and serum C-reactive protein (CRP) levels (to measure systemic inflammation). A pilot study was conducted prior to commencing the main study to assess the feasibility and reliably of measurement of some of the clinical tests that have been proposed for the main study. Air pollutant exposure measurements were not included in the pilot study.
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Affiliation(s)
- Wafaa Nabil Ezz
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
| | - Mandana Mazaheri
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Paul Robinson
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Samuel Clifford
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Congrong He
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, 2 George Street, Brisbane, QLD 4000, Australia.
| | - Guy B Marks
- Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia.
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
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Lin R, Guan R, Liu X, Zhao B, Guan J, Lu L. Significant rise of the prevalence and clinical features of childhood asthma in Qingdao China: cluster sampling investigation of 10,082 children. BMC Public Health 2014; 14:1002. [PMID: 25256616 PMCID: PMC4192336 DOI: 10.1186/1471-2458-14-1002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 08/07/2014] [Indexed: 12/05/2022] Open
Abstract
Background Recent investigations suggested that the trend of childhood asthma has been stabilizing or even reversing in some countries. The observation provides contrast to our experience. Thus, the study aimed to investigate the prevalence and clinical features of asthma in children aged 0–14 years in Qingdao China, determine the changes of childhood asthma in China, and discover evidence that can allow better diagnosis and treatment of childhood asthma. Methods A cluster sampling method was used. We randomly extracted the investigation clusters from schools, kindergartens, and communities in Qingdao. Subsequently, we interviewed the members of the clusters using a questionnaire from the International Study of Asthma and Allergies in Childhood (ISAAC) to find children with asthmatic symptoms. After determination by the doctors, more details on the asthmatic children were obtained by asking questions from the National Epidemiology Study of Asthma and Allergies in China questionnaire to obtain more details. We intended to survey 10,800 children. However, the actual number of children was 10,082. Results The prevalence of asthma in Qingdao children aged 0–14 years was 3.69%. The prevalence among male children was higher than in female (χ2 = 24.53,P < 0.01). Among the asthmatic children, 68.0% had their first attack when they were less than three years old. Moreover, 71.2% once suffered respiratory tract infections. For 95.7% of asthmatic children, the asthma attack was first manifested as cough. Asthmatic children who used inhaled corticosteroids (ICS) only accounted for 46%. Conclusions The prevalence of asthma in children aged 0–14 years in Qingdao China increased significantly based on data obtained ten years ago (2000). Respiratory tract infections were the most important precursors of asthma attack. The attack was most commonly manifested as cough. The treatment, especially the use of ICS, was more rational. However, a certain difference was found, which has yet to be contrasted with the Global Initiative for Asthma (GINA) project.
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Affiliation(s)
- Rongjun Lin
- The Affiliated Hospital of Qingdao University, Qingdao 266003, China.
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Hansell AL, Rose N, Cowie CT, Belousova EG, Bakolis I, Ng K, Toelle BG, Marks GB, for the Childhood Asthma Prevention Study Team, Childhood Asthma Prevention Study Team Almqvistplus CatarinaAmponRosario DAyerJulianBirdTessaBrewBronwyn KBrittonWarwick JCelermajerDavidCowellChristopher TCrisafulliDanieleCrissSallyDavisStellaNabil EzzWafaaForbesSamanthaGardenFrances LKempAndrew SKnezevicNataliaKrauseWilliamLeederStephen RMellisCraig MMihrshahiSeemaNeumannMarkPeatJennifer KQuinones-LucioAndresSkiltonMichaelTattamAnneToveyEuan RVanlaarCarl H.VukasinNicolaWainwrightCraigWebbKaren LWeber-ChrysochoouChristinaWoolcockAnn JZhouJie. Weighted road density and allergic disease in children at high risk of developing asthma. PLoS One 2014; 9:e98978. [PMID: 24949625 PMCID: PMC4064977 DOI: 10.1371/journal.pone.0098978] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 05/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background Evidence for an association between traffic-related air pollution and allergic disease is inconsistent, possibly because the adverse effects may be limited to susceptible subgroups and these have not been identified. This study examined children in the Childhood Asthma Prevention Study (CAPS), potentially susceptible to air pollution effects because of a family history of asthma. Methods We examined cross-sectional associations at age eight years between road density within 75 m and 50 m of home address weighted by road type (traffic density), as a proxy for traffic-related air pollution, on the following allergic and respiratory outcomes: skin prick tests (SPTs), total and specific serum IgE, pre- and post-bronchodilator lung function, airway hyperresponsiveness, exhaled NO, and reported asthma and rhinitis. Results Weighted road density was positively associated with allergic sensitisation and allergic rhinitis. Adjusted relative risk (RR) for house dust mite (HDM) positive SPT was 1.25 (95% CI: 1.06–1.48), for detectable house dust mite-specific IgE was 1.19 (95% CI: 1.01–1.41) and for allergic rhinitis was 1.30 (95% CI: 1.03–1.63) per 100 m local road or 33.3 m motorway within 50 m of home. Associations were also seen with small decrements of peak and mid-expiratory flows and increased risk of asthma, current wheeze and rhinitis in atopic children. Conclusion Associations between road density and allergic disease were found in a potentially susceptible subgroup of children at high risk of developing atopy and asthma.
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Affiliation(s)
- Anna L. Hansell
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
- Public Health and Primary Care Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
| | - Nectarios Rose
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- New South Wales Health Ministry, Sydney, New South Wales, Australia
| | - Christine T. Cowie
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Elena G. Belousova
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ioannis Bakolis
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Kitty Ng
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Brett G. Toelle
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Guy B. Marks
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Department of Respiratory Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
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Song N, Shamssain M, Mohammed S, Zhang J, Wu J, Fu C, Hao S, Guan J, Yan X. Prevalence, severity and risk factors of asthma, rhinitis and eczema in a large group of Chinese schoolchildren. J Asthma 2013; 51:232-42. [PMID: 24303994 DOI: 10.3109/02770903.2013.867973] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a lack of information on the prevalence, severity and risk factors of asthma, rhinitis and eczema in Chinese children. OBJECTIVE To establish baseline data for a major longitudinal study of factors affecting asthma, rhinitis and eczema in a large group of children from the industrialized city of Shijiazhuang, China. METHODS We used the International Study of Asthma and Allergies in Childhood questionnaire and studied 10 338 children, ages 6-18, from Shijiazhuang. RESULTS The prevalence of childhood asthma, rhinitis and eczema is 1.2%, 13.5% and 11.8%, respectively. Boys had higher prevalence of these conditions than girls and younger children had higher prevalence of asthma and eczema but lower prevalence of rhinitis than older children. Breastfed children had lower prevalence of asthma and rhinitis, but not eczema, than non-breastfed children. Overweight children had higher prevalence of asthma and rhinitis than those who were not overweight. Children exposed to paternal smoking had higher prevalence of rhinitis and eczema than those not exposed; children exposed to pets had higher prevalence of asthma and rhinitis than those not exposed. CONCLUSIONS The prevalence of asthma in this study group is low, but the prevalence of rhinitis is high, and could be considered a major public health problem. The prevalence of asthma, rhinitis and eczema is generally higher in boys and younger children generally have higher prevalence of asthma and eczema but lower prevalence of rhinitis. Exposure to pets is a risk factor for rhinitis, being overweight is a risk factor for asthma and rhinitis, and exposure to parental smoking is a risk factor for asthma, rhinitis and eczema in these children.
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Affiliation(s)
- Ning Song
- Department of Respiratory Medicine, the Second Hospital of Hebei Medical University , Shijiazhuang, Hebei , P.R. China
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Bjerg A. The changing face of asthma in Finland: improved recognition and no further increase in symptoms. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:13-4. [PMID: 23426421 PMCID: PMC6442772 DOI: 10.4104/pcrj.2013.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anders Bjerg
- (Post-doctoral) Researcher, Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Krefting Research Centre Göteborgs Universitet, Box 424, S-405 30 Göteborg, Sweden Tel: +46(0)707 604459 Fax: +46(0)31786 6730 E-mail:
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Schmitz R, Ellert U, Kalcklösch M, Dahm S, Thamm M. Patterns of sensitization to inhalant and food allergens - findings from the German Health Interview and Examination Survey for Children and Adolescents. Int Arch Allergy Immunol 2013; 162:263-70. [PMID: 24022179 DOI: 10.1159/000353344] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 05/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the prevalence of allergic sensitization and to analyze patterns of sensitization to common inhalant and food allergens in a nationwide representative sample of children and adolescents in Germany. METHODS Data were collected from 2003 to 2006 within the KiGGS, the national Health Interview and Examination Survey covering a representative sample of 17,641 children and adolescents in Germany. Immunoglobulin E (IgE) antibodies to 20 specific allergens (11 inhalant and 9 food allergens) were quantitatively measured in a subsample of 12,988 KiGGS participants aged 3-17 years using the ImmunoCAP system. Serum concentrations ≥0.35 kU/l indicate sensitized participants. An exploratory factor analysis was performed in order to identify sensitization patterns. RESULTS Sensitization to at least 1 of the 20 tested allergens was detected in 40.2% [95% confidence interval (CI) 39.0-41.4] of the participants. The highest sensitization prevalences were found for pollen from Timothy grass (22.7%; 21.5-23.9) and rye (21.2%; 20.0-22.4). Sensitization was more prevalent in boys than in girls and prevalence increased generally with increasing age. We identified seven sensitization groups, namely (in descending order of magnitude) 'Timothy grass/rye', 'house-dust mites', 'food/mugwort', 'birch/apple', 'animals', 'cow's milk/egg white' and 'moulds'. CONCLUSIONS Allergic sensitization is common in German children and adolescents. The fact that sensitization potentially leads to clinically relevant allergic diseases stresses the public health relevance of this topic. Whether the grouping reflects the propensity for persons to be sensitized to multiple allergens within a group, or whether it is due to IgE cross-reactivity between different allergens of similar structure is still being discussed.
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Affiliation(s)
- Roma Schmitz
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Kim SY, Jung JY, Park MS, Kang YA, Kim EY, Kim SK, Chang J, Kim YS. Increased prevalence of self-reported asthma among Korean adults: an analysis of KNHANES I and IV data. Lung 2013; 191:281-8. [PMID: 23483196 DOI: 10.1007/s00408-013-9453-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Asthma is one of the most common chronic conditions. Knowing the longitudinal trends of prevalence is important in developing health service planning and in assessing the impact of the disease. However, there have been no studies that examined current asthma prevalence trends in Korea through the analysis of nationwide surveys. METHODS Data were acquired from patients aged 20-59 years who participated in the First Korean National Health and Nutritional Examination Surveys (KNHANES), which was conducted in 1998, and in the second year of the Fourth KNHANES, which was conducted in 2008. To estimate the prevalence of asthma with age and gender standardization, we used data from the Population and Housing Census, which was conducted by Statistics Korea in 2005. RESULTS The prevalence of physician-diagnosed asthma increased from 1998 to 2008 (1998: 0.7 %, 2008: 2.0 %). The prevalence of asthma medication usage also increased from 1998 to 2008 (1998: 0.3 %, 2008: 0.7 %); however, the prevalence of wheezing decreased between 1998 and 2008 (1998: 13.7 %, 2008: 6.3 %). A similar trend was observed after estimating the prevalence of asthma with age and gender standardization. Allergic rhinitis might be the reason for the increased prevalence of physician-diagnosed asthma, while the observed decrease in wheezing may be related to the decrease in smoking or the increase in the use of asthma medication. CONCLUSIONS The present study showed that the prevalence of both self-reported physician-diagnosed asthma and asthma medication usage increased from 1998 to 2008 in Korea, despite a possible changing pattern of diagnosing asthma.
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Affiliation(s)
- Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
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Willenborg C, Stelzer-Braid S. Sneezing leads to wheezing: microorganisms important in asthma. MICROBIOLOGY AUSTRALIA 2013. [DOI: 10.1071/ma13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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van Aalderen WM. Childhood asthma: diagnosis and treatment. SCIENTIFICA 2012; 2012:674204. [PMID: 24278725 PMCID: PMC3820621 DOI: 10.6064/2012/674204] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/18/2012] [Indexed: 05/31/2023]
Abstract
Many children suffer from recurrent coughing, wheezing and chest tightness. In preschool children one third of all children have these symptoms before the age of six, but only 40% of these wheezing preschoolers will continue to have asthma. In older school-aged children the majority of the children have asthma. Quality of life is affected by asthma control. Sleep disruption and exercised induced airflow limitation have a negative impact on participation in sports and social activities, and may influence family life. The goal of asthma therapy is to achieve asthma control, but only a limited number of patients are able to reach total control. This may be due to an incorrect diagnosis, co-morbidities or poor inhalation technique, but in the majority of cases non-adherence is the main reason for therapy failures. However, partnership with the parents and the child is important in order to set individually chosen goals of therapy and may be of help to improve control. Non-pharmacological measures aim at avoiding tobacco smoke, and when a child is sensitised, to avoid allergens. In pharmacological management international guidelines such as the GINA guideline and the British Guideline on the Management of Asthma are leading.
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Affiliation(s)
- Wim M. van Aalderen
- Department of Pediatric Respiratory Disease and Allergy, Emma Children's Hospital AMC, Meibergdreef 7, 1105 AZ Amsterdam, The Netherlands
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Cowie CT, Rose N, Ezz W, Xuan W, Cortes-Waterman A, Belousova E, Toelle BG, Sheppeard V, Marks GB. Respiratory health before and after the opening of a road traffic tunnel: a planned evaluation. PLoS One 2012; 7:e48921. [PMID: 23209560 PMCID: PMC3510202 DOI: 10.1371/journal.pone.0048921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/01/2012] [Indexed: 11/18/2022] Open
Abstract
Objective The construction of a new road tunnel in Sydney, Australia, and concomitant reduction in traffic on a major road presented the opportunity to study the effects of this traffic intervention on respiratory health. Methods We made measurements in a cohort of residents in the year before the tunnel opened (2006) and in each of two years afterwards (2007–2008). Cohort members resided in one of four exposure zones, including a control zone. Each year, a respiratory questionnaire was administered (n = 2,978) and a panel sub-cohort (n = 380) performed spirometry once and recorded peak expiratory flow and symptoms twice daily for nine weeks. Results There was no consistent evidence of improvement in respiratory health in residents living along the bypassed main road, despite a reduction in traffic from 90,000 to 45,000 vpd. Residents living near tunnel feeder roads reported more upper respiratory symptoms in the survey but not in the panel sub-cohort. Residents living around the tunnel ventilation stack reported more upper and lower respiratory symptoms and had lower spirometric volumes after the tunnel opened. Air pollutant levels measured near the stack did not increase over the study period. Conclusion The finding of adverse health effects among residents living around the stack is unexpected and difficult to explain, but might be due to unmeasured pollutants or risk factors or an unrecognized pollutant source nearby. The lack of improvement in respiratory health among people living along the bypassed main road probably reflects a minimal change in exposure due to distance of residence from the road.
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Sa-Sousa A, Morais-Almeida M, Azevedo LF, Carvalho R, Jacinto T, Todo-Bom A, Loureiro C, Bugalho-Almeida A, Bousquet J, Fonseca JA. Prevalence of asthma in Portugal - The Portuguese National Asthma Survey. Clin Transl Allergy 2012; 2:15. [PMID: 22931550 PMCID: PMC3480869 DOI: 10.1186/2045-7022-2-15] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/21/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Asthma is a frequent chronic respiratory disease in both children and adults. However, few data on asthma prevalence are available in Portugal. The Portuguese National Asthma Survey is the first nationwide study that uses standardized methods. We aimed to estimate the prevalence of current asthma in the Portuguese population and to assess the association between 'Current asthma' and comorbidities such as upper airways disease. METHODS A cross-sectional, population-based, telephone interview survey including all municipalities of Portugal was undertaken. Participants were randomly selected to answer a questionnaire based on the Portuguese version of the GA2LEN survey. 'Current asthma' was defined as self-reported lifetime asthma and at least one of 3 symptoms in the last 12 months: wheezing, waking with breathlessness or having an asthma attack. RESULTS Data were obtained for 6 003 respondents, with mean age of 38.9 (95%CI 38.2-39.6) years and 57.3% females. In the Portuguese population, the prevalence of 'Current asthma' was 6.8% (95%CI 6.0-7.7) and of 'Lifetime asthma' was 10.5% (95%CI 9.5-11.6) Using GA2LEN definition for asthma, our prevalence estimate was 7.8% (95%CI 7.0-8.8). Rhinitis had a strong association with asthma (Adjusted OR 3.87, 95%CI 2.90-5.18) and the association between upper airway diseases and asthma was stronger in patients with both rhinitis and sinusitis (Adjusted OR 13.93, 95%CI 6.60-29.44). CONCLUSIONS Current asthma affects 695 000 Portuguese, with a prevalence of 6.8%. People who reported both rhinitis and sinusitis had the highest risk of having asthma.
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Affiliation(s)
- Ana Sa-Sousa
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Division Unit, Hospital CUF-Descobertas, Lisbon, Portugal
- Sociedade Portuguesa de Alergologia e Imunologia Clínica, LIsbon, Portugal
| | - Luis Filipe Azevedo
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Tiago Jacinto
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Allergy Unit, Hospital and Institute CUF, Porto, Portugal
| | - Ana Todo-Bom
- Sociedade Portuguesa de Alergologia e Imunologia Clínica, LIsbon, Portugal
- Allergy and Clinical Immunology Division, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Carlos Loureiro
- Sociedade Portuguesa de Alergologia e Imunologia Clínica, LIsbon, Portugal
- Allergy and Clinical Immunology Division, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - António Bugalho-Almeida
- Clínica Universitária de Pneumologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Coordinator of Comissão de Acompanhamento do Programa Nacional de Controlo da Asma, Lisbon, Portugal
| | - Jean Bousquet
- Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - João Almeida Fonseca
- Center for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Health Information and Decision Sciences Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Allergy Unit, Hospital and Institute CUF, Porto, Portugal
- Allergy and Clinical Immunology Division, Hospital S. João EPE, Porto, Portugal
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Deckers IAG, McLean S, Linssen S, Mommers M, van Schayck CP, Sheikh A. Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLoS One 2012; 7:e39803. [PMID: 22808063 PMCID: PMC3394782 DOI: 10.1371/journal.pone.0039803] [Citation(s) in RCA: 379] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 05/30/2012] [Indexed: 02/06/2023] Open
Abstract
The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner.
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Affiliation(s)
- Ivette A G Deckers
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
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Cheraghi M, Dadgarinejad A, Salvi S. A Cross-Sectional Study to Find Prevalence and Risk Factors for Childhood Asthma in Pune City, India. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/361456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We aimed to determine current prevalence of asthma and risk factors associated with it in Pune, India. Methods. This was a cross-sectional school-population-based study in which parents of school children aged 6-7 and 13-14 were administered an ISAAC questionnaire and an additional set of questions that detected the presence of potential risk factors known to be associated with asthma during 2008-2009 academic years. Results. Prevalence of current asthma was 6.7% (7% amongst 6-7-year olds and 6.3% amongst 13-14 year olds. Asthma was more common amongst boys (8.1%) than girls (4.9%) and more frequent in students studying in private schools (7.3%) than in those studying in public schools (5.8%). Risk factors such as family history of atopy, caesarian delivery, use of biomass fuel for cooking, absence of separate kitchen, absence of exclusive breastfeeding during the first 6 months of life, preterm birth, snoring, dampness at home, male sex, and parental smoking were significantly associated with asthma. Conclusion. There was a high prevalence of childhood asthma in Pune, India, which was associated with genetic and environmental risk factors.
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Affiliation(s)
- Maria Cheraghi
- Department of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Cowie CT, Ezz W, Xuan W, Lilley W, Rose N, Rae M, Marks GB. A randomised cross-over cohort study of exposure to emissions from a road tunnel ventilation stack. BMJ Open 2012; 2:bmjopen-2012-001201. [PMID: 22904331 PMCID: PMC3425893 DOI: 10.1136/bmjopen-2012-001201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Road tunnels are increasingly important components of urban infrastructure. However, knowledge of their health impact on surrounding communities is limited. Our objective was to estimate the short-term respiratory health effects of exposure to emissions from a road tunnel ventilation stack. METHODS We conducted a randomised cross-over cohort study in 36 volunteers who underwent three exposure scenarios in 2006 before the road tunnel opened, and in 2007 (n=27) and 2008 (n=20) after the tunnel opened. Exposure downwind of the stack was compared to upwind of the stack and to a distant heavily trafficked location adjacent to a main road. Spirometry, exhaled nitric oxide (eNO) and symptom scores were measured repeatedly during each 2 h exposure session. RESULTS Downwind locations were associated with increased reports of 'dry nose' (score difference 0.36; 95% CI 0.09 to 0.63) compared with the control location (2006 vs 2007/2008), but not with impaired lung function, increased airway inflammation or other symptoms. The heavily trafficked location was associated with significantly increased eNO (ratio=1.09; 95% CI 1.04 to 1.14), eye (score difference 0.05; 95% CI 0.01 to 0.10) and chest (score difference 0.21; 95% CI 0.09 to 0.33) symptoms compared to the stack locations. CONCLUSIONS There was no consistent evidence of adverse respiratory effects from short-term exposures downwind of the tunnel ventilation stack, except for dry nose symptoms. However, the findings of increased airway inflammation and symptoms in subjects after only 2 h exposure at the heavily trafficked location, are suggestive of detrimental effects of short-term exposures to traffic-related air pollution.
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Affiliation(s)
- Christine T Cowie
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Cooperative Research Centre for Asthma and Airways, Sydney, Australia
| | - Wafaa Ezz
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Cooperative Research Centre for Asthma and Airways, Sydney, Australia
| | - Wei Xuan
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Cooperative Research Centre for Asthma and Airways, Sydney, Australia
| | - William Lilley
- Commonwealth Scientific and Industrial Research Organisation, Newcastle, Australia
| | - Nectarios Rose
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- NSW Health Department, Sydney, New South Wales, Australia
| | - Michael Rae
- Commonwealth Scientific and Industrial Research Organisation, Newcastle, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
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Warm K, Backman H, Lindberg A, Lundbäck B, Rönmark E. Low incidence and high remission of allergic sensitization among adults. J Allergy Clin Immunol 2012; 129:136-42. [DOI: 10.1016/j.jaci.2011.08.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 08/17/2011] [Accepted: 08/24/2011] [Indexed: 11/26/2022]
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Yura A, Kouda K, Iki M, Shimizu T. Trends of allergic symptoms in school children: large-scale long-term consecutive cross-sectional studies in Osaka Prefecture, Japan. Pediatr Allergy Immunol 2011; 22:631-7. [PMID: 21466587 DOI: 10.1111/j.1399-3038.2011.01159.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trends in the prevalence rates of allergic symptoms in children have been discussed extensively, but it remains uncertain which symptoms increase or decrease over time owing to the lack of large-scale long-term consecutive cross-sectional studies performed on a representative population of children. OBJECTIVE To clarify the trends in the prevalence rates of allergic symptoms in Japanese children. METHODS Total population questionnaire surveys were conducted 15 times from 1975 to 2006 for all children attending public elementary schools in Osaka Prefecture, Japan, with the number of subjects ranging from 460,000 to 900,000. Parents of the children completed the questionnaire about allergic symptoms and other symptoms, including wheeze, physician-diagnosed atopic dermatitis, rhinitis, and itching eyes. RESULTS Response rates were consistently over 90%. The prevalence of wheezing was constant until 1983, then increased from 1983 until 1993, then stabilized at about 4.4%. The lifetime prevalence of atopic dermatitis increased to 24% by 1993, and then decreased. The prevalence of rhinitis increased to 25% by 2003, whereas the prevalence of non-seasonal symptoms plateaued from 1993 on at 11% and vernal symptoms increased. The prevalence of itching eyes continued to increase to 21% in 2006, and vernal symptoms increased sharply. CONCLUSIONS In Osaka Prefecture, Japan, the turning point when the prevalence of wheezing in schoolchildren had begun to increase was 1983. And the turning point when the increase in the prevalence of wheezing, atopic dermatitis, and non-seasonal allergic rhinitis turned to decrease or constant was 1993. The prevalence of rhinitis and itching eyes in spring was still increasing in 2006.
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Affiliation(s)
- Akiko Yura
- Department of Public Health, Kinki University Faculty of Medicine, Osaka, Japan.
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Patel SP, Rodriguez A, Little MP, Elliott P, Pekkanen J, Hartikainen AL, Pouta A, Laitinen J, Harju T, Canoy D, Järvelin MR. Associations between pre-pregnancy obesity and asthma symptoms in adolescents. J Epidemiol Community Health 2011; 66:809-14. [PMID: 21844604 PMCID: PMC3412048 DOI: 10.1136/jech.2011.133777] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background The high prevalence of children's asthma symptoms, worldwide, is unexplained. We examined the relation between maternal pre-pregnancy weight and body mass index (BMI), and asthma symptoms in adolescents. Methods Data from 6945 adolescents born within the Northern Finland Birth Cohort 1986 were used. Prospective antenatal and birth outcome data, including maternal pre-pregnancy weight and BMI, and asthma symptoms in adolescent offspring at age 15–16 years, were employed. Logistic regression analyses were performed to examine the associations between relevant prenatal factors and asthma symptoms during adolescence. Results Current wheeze (within the past year) was reported by 10.6% of adolescents, and physician-diagnosed asthma by 6.0%. High maternal pre-pregnancy BMI was a significant predictor of wheeze in the adolescents (increase per kilogram per square metre unit; 2.7%, 95% CI 0.9 to 4.4 for ever wheeze; 3.5%, 95% CI 1.3 to 5.8 for current wheeze), and adjusting for potential confounders further increased the risk (2.8%, 95% CI 0.5 to 5.1; 4.7%, 95% CI 1.9 to 7.7, respectively). High maternal pre-pregnancy weight, in the top tertile, also significantly increased the odds of current wheeze in the adolescent by 20% (95% CI 4 to 39), and adjusting for potential confounders further increased the risk (OR=1.52, 95% CI 1.19 to 1.95). Results were similar for current asthma. Furthermore, these significant associations were observed only among adolescents without parental history of atopy but not among those with parental history of atopy. Conclusions The association demonstrated here between maternal pre-pregnancy overweight and obesity, and asthma symptoms in adolescents suggests that increase in asthma may be partly related to the rapid rise in obesity in recent years.
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Affiliation(s)
- Swatee P Patel
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK
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Affiliation(s)
- Göran Wennergren
- Department of Paediatrics and Krefting Research Centre, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden.
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Pegas PN, Alves CA, Scotto MG, Evtyugina MG, Pio CA, Freitas MC. [Risk factors and prevalence of asthma and rhinitis among primary school children in Lisbon]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 17:109-16. [PMID: 21549669 DOI: 10.1016/j.rppneu.2011.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 08/02/2010] [Indexed: 10/18/2022] Open
Abstract
AIMS A cross-sectional study was carried out with the objective of identifying nutrition habits and housing conditions as risk factors for respiratory problems in schoolchildren in Lisbon. MATERIAL AND METHODS Between October and December 2008, parents of 900 students of the basic schools of Lisbon were invited to answer a questionnaire of the International Study of Asthma and Allergies in Childhood Program (ISAAC). The response rate was 40%. Logistic regression was used in the analysis of results. RESULTS The prevalence of asthma, allergic rhinitis and wheeze was 5.6%, 43.0% and 43.3%, respectively. Risk factors independently associated with asthma were wheezing attacks, and dry cough at night not related to common cold in the last 12 months. Wheezing crises were found to affect children daily activities. Risk factors for wheeze were hay fever and the presence of a pet at home. A risk factor for rhinitis was cough at night. The frequent consumption of egg was also associated with increased risk of rhinitis. CONCLUSION Contrarily to asthma, the prevalence of allergic rhinitis and wheeze increased in comparison with previous ISAAC studies. Wheezing attacks were associated with asthma and hay fever was identified as a risk factor of manifesting wheezing symptoms. Having pets at home was pointed out as a significant risk factor for rhinitis, but not smoking exposure, mould, plush toys, diet (except egg consumption), breastfeeding or other conditions.
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Affiliation(s)
- P N Pegas
- Centro de Estudos do Ambiente e do Mar, Departamento de Ambiente e Ordenamento, Universidade de Aveiro, Aveiro, Portugal.
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Zilmer M, Steen NP, Zachariassen G, Duus T, Kristiansen B, Halken S. Prevalence of asthma and bronchial hyperreactivity in Danish schoolchildren: no change over 10 years. Acta Paediatr 2011; 100:385-9. [PMID: 20874825 DOI: 10.1111/j.1651-2227.2010.02036.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe the point prevalence of current physician-diagnosed asthma and bronchial hyperreactivity (BHR) in 2001 among unselected Danish schoolchildren aged 6-17 years, compared with the prevalence from a similar study from 1990 to 1991. METHODS Cross-sectional study using parental questionnaire on asthma and respiratory symptoms combined with a 6-min free running test with peak expiratory flow rate (PEFR) measurement (n = 1051, response rate 89.3%). Results were compared with those of a similar study in the same area from 1990 to 1991. Main outcome measures were current physician-diagnosed asthma or BHR in children without physician-diagnosed asthma measured by either a decrease in lung function after standardized running test and/or variability in PEFR on home monitoring. RESULTS The prevalence of current physician-diagnosed asthma was 4.0% [95% confidence interval (CI) 2.7-5.3%] in 1990-1991 and 3.6% (95% CI 2.4-4.8%) in 2001. The prevalence of BHR was 3.2% (95% CI 2.0-4.4%) in 1990-1991 and 2.0% (95% CI 1.1-2.9%) in 2001. The combined prevalence was 7.2% (95% CI 5.4-8.9%) in 1990-1991 and 5.6% (95% CI 4.2-7.1%) in 2001. CONCLUSION The point prevalence of current physician-diagnosed asthma and BHR among unselected Danish schoolchildren aged 6-17 years was unchanged over 10 years between 1990-1991 and 2001.
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Affiliation(s)
- M Zilmer
- Department of Pediatrics, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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CHERECHES-PANTA P, C. S, DUMITRESCU D, MARSHALL M, MIRESTEAN I, MURESAN M, IACOB D, FARCAU M, ICHIM GE, NANULESCU MV. Epidemiological survey 6 years apart: increased prevalence of asthma and other allergic diseases in schoolchildren aged 13-14 years in cluj-napoca, romania (based on isaac questionnaire). MAEDICA 2011; 6:10-16. [PMID: 21977184 PMCID: PMC3150021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The prevalence of asthma and allergy has increased during recent decades. OBJECTIVE We investigate the prevalence of asthma and other allergic diseases in children aged 13-14 years and we evaluate the trend of prevalence after an interval of 6 years. MATERIAL AND METHODS We used a core questionnaire designed by the International Study of Asthma and Allergy in Children. In 1991, the questionnaire was administered to 2,866 children from a Romanian city and during 2001 to 1,657 children from the same area. RESULTS The prevalence of asthma increased from 3.3% in 1995 to 5.5% in 2001 (p<0.001). In 1995, 4.3% of children reported asthma-related symptoms, significantly fewer than the percentage 6 years later (13.6%; p<0.00001). Similar results were obtained with regard to allergic rhinitis (13.6% versus 20%; p<0.00001) and eczema (11.5% versus 16.2%; p=0.00015). As far as gender differences are concerned, in the first stage of study all three allergic disorders were found to occur more frequently in females. In the study undertaken in 2001, females proved to have a higher prevalence of asthma (p=0.226), but a lower prevalence for allergic rhinitis (p=0.121) and eczema (p=0.064). CONCLUSIONS The prevalence of asthma and allergy increased significantly during the past 6 years.
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Affiliation(s)
| | - Sorin C.
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3 Paediatric Department, Cluj-Napoca, Romania
| | - Diana DUMITRESCU
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3 Medical Clinic, Allergy Department, Cluj-Napoca, Romania
| | - Mirela MARSHALL
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3 Medical Clinic, Allergy Department, Cluj-Napoca, Romania
| | | | - Mariana MURESAN
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3 Paediatric Department, Cluj-Napoca, Romania
| | - Daniela IACOB
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3 Paediatric Department, Cluj-Napoca, Romania
| | - Mihaela FARCAU
- Children's Clinical Emergency Hospital, 3 Paediatric Clinic, Cluj-Napoca, Romania
| | - Gabriela E. ICHIM
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3 Paediatric Department, Cluj-Napoca, Romania
| | - Mircea V. NANULESCU
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3 Paediatric Department, Cluj-Napoca, Romania
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de Meer G, Reijneveld SA, Brunekreef B. Wheeze in children: the impact of parental education on atopic and non-atopic symptoms. Pediatr Allergy Immunol 2010; 21:823-30. [PMID: 19912550 DOI: 10.1111/j.1399-3038.2009.00971.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is conflicting evidence for the relationship between parental socioeconomic position and their children's asthma. The aim of this study was to investigate relationships between parental education and respiratory symptoms in their children, distinguishing atopic and non-atopic symptoms. A cross-sectional survey among 3262 elementary school children (age 8-13) was performed; data on parental education were obtained for 3213 children. Parents completed a questionnaire on their child's allergic and respiratory symptoms, and potential explanatory variables including family history, indoor environment, and the child's medical history. Subsets of children were tested for atopy (n = 1983), lung function (n = 2325), and airway hyperresponsiveness (AHR) (n = 880). Logistic regression was used to assess relationships of health outcomes with parental education. A high parental education was associated with an increased risk of atopic sensitization to indoor allergens (OR 1.31, 95% CI 1.02; 1.69). Studied explanatory variables did not influence the relationship. In contrast, a high parental education protected children from wheeze (OR 0.77, 95% CI 0.61; 0.97). This only applied to non-atopic wheeze (OR 0.65, 95% CI 0.43; 0.99) and not to atopic wheeze (OR 0.89, 95% CI 0.60; 1.31). The protection from non-atopic wheeze in children of highly educated parents declined after adjustment for household smoking and breastfeeding (OR 0.96, 95% CI 0.58; 1.57). Similar results were observed for non-atopic and atopic rhinitis. We conclude that children from highly educated parents are protected from non-atopic respiratory symptoms, which is largely explained by a lower rate of household smoking and a higher rate of breastfeeding.
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Affiliation(s)
- Gea de Meer
- Municipal Health Service Fryslân, Leeuwarden, The Netherlands.
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Wennergren G, Ekerljung L, Alm B, Eriksson J, Lötvall J, Lundbäck B. Asthma in late adolescence--farm childhood is protective and the prevalence increase has levelled off. Pediatr Allergy Immunol 2010; 21:806-13. [PMID: 20408968 DOI: 10.1111/j.1399-3038.2010.01057.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While the prevalence of and risk factors for asthma in childhood have been studied extensively, the data for late adolescence are more sparse. The aim of this study was to provide up-to-date information on the prevalence of and risk factors for asthma in the transitional period between childhood and adulthood. A secondary aim was to analyze whether the increase in asthma prevalence has levelled off. A large-scale, detailed postal questionnaire focusing on asthma and respiratory symptoms, as well as possible risk factors, was mailed to 30 000 randomly selected subjects aged 16-75 in Gothenburg and the surrounding western Sweden region. The present analyses are based on the responses from 1261 subjects aged 16-20 (560 men and 701 women). The prevalence of physician-diagnosed asthma was 9.5%, while 9.6% reported the use of asthma medicine. In the multivariate analysis, the strongest risk factors for physician-diagnosed asthma and other asthma variables were heredity for asthma and heredity for allergy, particularly if they occurred together. Growing up on a farm significantly reduced the prevalence of physician-diagnosed asthma and the likelihood of using asthma medication, OR 0.1 (95% CI 0.02-0.95). Smoking increased the risk of recurrent wheeze, long-standing cough, and sputum production. In conclusion, the prevalence of physician-diagnosed asthma and the use of asthma medication in the 16- to 20-yr age group support the notion that the increase in asthma prevalence seen between the 1950s and the 1990s has now levelled off. In line with the hygiene hypothesis, a farm childhood significantly reduced the likelihood of asthma. The adverse effects of smoking could already be seen at this young age.
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Affiliation(s)
- Göran Wennergren
- Krefting Research Centre, Department of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Bjerg A, Rönmark E. Asthma in school age: prevalence and risk factors by time and by age. CLINICAL RESPIRATORY JOURNAL 2010; 2 Suppl 1:123-6. [PMID: 20298361 DOI: 10.1111/j.1752-699x.2008.00095.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Childhood is the most important age for asthma development. Recent reports indicate that the prevalence of asthma in children has plateaued after having increased for decades. AIMS To study prevalence and risk factor patterns of asthma by age and by time. METHODS In 1996, all children in grade 1-2 (age 7-8) in three cities in Northern Sweden were invited to an expanded International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. A total of 3430 children (97%) participated yearly until 2000 (age 11-12). A subset (n = 2454) was invited to skin-prick testing in 1996 and 2000 with 88% and 90% participation. In 2006, another cohort (n = 2704) was identified and studied by identical methods with 96% participation. A total of 1700 children (90% of invited) were skin-prick tested. RESULTS AND COMMENTS From age 7-8 to 11-12, the prevalence of physician-diagnosed asthma increased, 5.7%-7.7% (P < 0.01) while current wheeze decreased, 11.7%-9.4% (P < 0.01), indicating a less diverse spectrum of symptoms with age. The yearly remission from asthma was 10% (lasting remission 5%), largely determined by allergic sensitisation. Allergic sensitisation (OR 5) and a family history of asthma (OR 3) were important risk factors for asthma at age 7-8 and 11-12. However, several other significant risk factors at age 7-8 (low birth weight, respiratory infections and house dampness) lost importance until age 11-12. Maternal and paternal asthma were equally important risk factors (OR 3-4) at age 7-8. Sibling asthma was only a marker of parental disease. FUTURE PERSPECTIVES Through comparison with the 2006 cohort, trends in prevalence and in risk factors from 1996 to 2006 will be studied.
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Affiliation(s)
- A Bjerg
- The OLIN Studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden.
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Abstract
Immunoglobulin E (IgE) antibodies are key effector molecules in the allergic inflammatory response and are also involved in the protection against extracellular parasites. Allergic symptoms often develop early in life, and the intrauterine environment has been proposed to play an important role in affecting the risk of later allergy development. The placenta constitutes a selective barrier between the maternal and foetal circulation. Recently, we reported that maternal IgE antibodies are present on foetal macrophages in the villous tissue of the human placenta irrespective of maternal allergy status. This review discusses the presence of IgE antibodies in the human placenta and its possible roles in normal and pathologic pregnancy. It also deals with the relationship between placental IgE and development of allergy during childhood. A better understanding of the role of IgE in placenta could give us clues on how to prevent allergy development in the future generations.
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